Provider Demographics
NPI:1659334993
Name:REYES, MACRINA M (RPAC MS)
Entity Type:Individual
Prefix:MRS
First Name:MACRINA
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:RPAC MS
Other - Prefix:
Other - First Name:MACRINA
Other - Middle Name:JEMMA
Other - Last Name:MAGAHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 SCHMIDTS LANE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-982-9631
Mailing Address - Fax:
Practice Address - Street 1:1130 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3623
Practice Address - Country:US
Practice Address - Phone:718-273-2277
Practice Address - Fax:718-720-4989
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25MP00056000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081990Medicare ID - Type Unspecified
P86697Medicare UPIN